Fewer than 48% of those surveyed said they discussed harms and
benefits with patients before letting the men decide. These doctors
“were more likely to endorse beliefs that scientific evidence does not
support screening, that patients should be told about the lack of
evidence, and that patients have a right to know the limitations of
screening; they were also less likely to endorse the belief that there
was no need to educate patients because they wanted to be screened.”

And let me remind you of the DECISIONS study that found
that “most prostate cancer screening decisions did not meet criteria
for shared decision making because subjects did not receive balanced
discussions of decision consequences, had limited knowledge, and were
not routinely asked for their preferences.”

The body of evidence is growing: many American men are not being
provided the evidence they need to make an informed decision about
prostate cancer screening. And harms may occur as a result.

"That 24% of respondents, who were surveyed in 2007, failed to
even discuss screening is disconcerting, especially because most
contemporaneous guidelines were encouraging informed decision-making.
Respondents who screened without discussion were more likely to cite
time barriers and malpractice concerns. A potential strategy for
overcoming these barriers would be to provide patients with decision
aids. These decision support tools, which can be written, video, or
web-based, have been shown to increase knowledge, reduce decisional
conflict, and could also facilitate shorter, more focused clinic
discussions. Furthermore, Washington State has passed legislation
recognizing that using a decision aid constitutes evidence of an
informed consent. The lawyer Ben Moulton (J Law Med Ethics Spring 2010)
has argued that using decision aids “establishes a higher burden of
proof for patients attempting to claim that they were not adequately
informed of risks or alternatives.” Screening for prostate cancer is a
complex, controversial, and important health decision that should be
based on the preferences of an informed patient. Health care providers
should engage patients in the decision-making process."

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